Efficient Delivery of Nerve Growth Factors to the Central Nervous System for Neural Regeneration.

The central nervous system (CNS) plays a central role in the control of sensory and motor functions, and the disruption of its barriers can result in severe and debilitating neurological disorders. Neurotrophins are promising therapeutic agents for neural regeneration in the damaged CNS. However, their penetration across the blood-brain barrier remains a formidable challenge, representing a bottleneck for brain and spinal cord therapy.

A Bioinspired Platform for Effective Delivery of Protein Therapeutics to the Central Nervous System.

Central nervous system (CNS) diseases are the leading cause of morbidity and mortality; their treatment, however, remains constrained by the blood-brain barrier (BBB) that impedes the access of most therapeutics to the brain. A CNS delivery platform for protein therapeutics, which is achieved by encapsulating the proteins within nanocapsules that contain choline and acetylcholine analogues, is reported herein. Mediated by nicotinic acetylcholine receptors and choline transporters, such nanocapsules can effectively penetrate the BBB and deliver the therapeutics to the CNS, as demonstrated in mice and non-human primates.

Surgical Treatment of Recurrent Lumbar Disk Herniation: A Systematic Review and Meta-analysis.

Consensus is lacking regarding optimal surgical treatment of recurrent lumbar disk herniation. A systematic search of multiple databases was conducted for studies evaluating outcomes after treatment for recurrent lumbar disk herniation. Treatment options included decompression surgeries and fusion surgeries.

Vertebral Augmentation is Superior to Nonoperative Care at Reducing Lower Back Pain for Symptomatic Osteoporotic Compression Fractures: A Meta-Analysis.

Study Design: This is a systematic review and meta-analysis.

Objective: This study's goal was to (i) assess the clinical outcomes with and without vertebral augmentation (VA) for osteoporotic vertebral compression fractures (VCFs) with versus without correlating signs and symptoms; and (ii) acute (symptoms <3 mo duration) and subacute VCFs (3-6 mo duration) versus chronic VCFs (>6 mo).

Summary Of Background Data: Previously, a randomized controlled trial in the New England Journal of Medicine concluded that vertebroplasty for osteoporotic VCFs provided no clinical benefit over sham surgery.

Accuracy and Safety of Percutaneous Lumbosacral Pedicle Screw Placement Using Dual-Planar Intraoperative Fluoroscopy.

Study Design: Retrospective case series with prospective arm.

Purpose: To assess the safety and accuracy of percutaneous lumbosacral pedicle screw placement (PLPSP) in the lumbosacral spine using intraoperative dual-planar fluoroscopy (DPF).

Overview Of Literature: There are several techniques available for achieving consistent, safe, and accurate results with PLPSP.

Efficacy of Vertebral Augmentation for Vertebral Compression Fractures: A Review of Meta-Analyses.

Introduction: Vertebral compression fracture incidence is rising with the growth of the geriatric population and is one of the leading disabilities in healthcare. However, the literature is conflicted on the benefits of vertebral augmentation versus nonoperative care for these fractures. The purpose of the current study was to perform a review of all meta-analyses in the literature comparing vertebral augmentation to nonoperative care and descriptively report the results.

The Effect of Ketorolac on Thoracolumbar Posterolateral Fusion: A Systematic Review and Meta-Analysis.

Study Design: Systematic review and meta-analysis.

Objective: The purpose of this study was to evaluate the effect of postoperative ketorolac administration (ie, dosage and duration of use) on pseudarthrosis following thoracolumbar posterolateral spinal fusions.

Summary Of Background Data: Ketorolac is a nonsteroidal anti-inflammatory drug often administered for pain control after spine surgery.

The Epidemiology of Vertebral Osteomyelitis in the United States From 1998 to 2013.

Study Design: This is a epidemiological database analysis.

Objectives: The objectives of this article are to assess the following characteristics of vertebral osteomyelitis (VO): (1) incidence and patient demographics, (2) mortality rate, (3) length-of-stay (LOS), and (4) admission costs.

Summary Of Background: VO is a serious disease with potentially devastating clinical consequences.

The Utility of Preoperative Magnetic Resonance Imaging for Determining the Flexibility of Sagittal Imbalance.

Background: Scoliosis X-rays are the gold standard for assessing preoperative lumbar lordosis; however, particularly for flexible lumbar deformities, it is difficult to predict from these images the extent of correction required, as standing radiographs cannot predict the thoracolumbar alignment after intraoperative positioning.

Objective: To determine the utility of preoperative MRI in surgical planning for patients with flexible sagittal imbalance.

Methods: We identified 138 patients with sagittal imbalance.

Effectiveness of Reoperations for Adjacent Segment Disease Following Lumbar Spinal Fusion.

Although several options are available to address adjacent segment disease (ASD), the most effective surgical treatment has not been determined. In addition, it is important to subdivide ASD into stenosis with or without instability to determine if a decompression alone vs an extension of fusion is necessary. A systematic search of multiple medical reference databases was conducted for studies on surgical treatment of ASD.

Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar Interbody Fusions: A Systematic Review and Meta-analysis of Comparative Studies.

Study Design: Systematic review and meta-analysis.

Objective: Compare the radiographic and clinical outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF).

Summary Of Background Data: ALIF and TLIF are 2 methods of achieving spinal arthrodesis.

Pelvic retroversion: a compensatory mechanism for lumbar stenosis.

OBJECTIVE The flexed posture of the proximal (L1-3) or distal (L4-S1) lumbar spine increases the diameter of the spinal canal and neuroforamina and can relieve symptoms of neurogenic claudication. Distal lumbar flexion can result in pelvic retroversion; therefore, in cases of flexible sagittal imbalance, pelvic retroversion may be compensatory for lumbar stenosis and not solely compensatory for the sagittal imbalance as previously thought. The authors investigate underlying causes for pelvic retroversion in patients with flexible sagittal imbalance.

Deep Wound Infections After Pediatric Scoliosis Surgery.

Study Design: Retrospective clinical and radiographic review.

Objective: The purpose of this study was to evaluate the characteristics of deep wound infection, as well as the potential factors that correlate to surgical site infection (SSI) in spine deformity surgery.

Summary Of Background Data: Preventing SSIs in pediatric spinal deformity surgery is a crucial task.

Utility of Intraoperative Neuromonitoring for Lumbar Pedicle Screw Placement Is Questionable: A Review of 9957 Cases.

Study Design: A retrospective database study.

Objective: The goal of this study was to (1) evaluate the trends in the use of electromyography (EMG) for instrumented posterolateral lumbar fusions (PLFs) in the United States and (2) assess the risk of neurological injury following PLFs with and without EMG.

Summary Of Background Data: Neurologic injuries from iatrogenic pedicle wall breaches during screw placement are known complications of PLFs.

Clinical Differences Between Monomicrobial and Polymicrobial Vertebral Osteomyelitis.

Little literature exists examining differences in presentation and outcomes between monomicrobial and polymicrobial vertebral infections. Seventy-nine patients treated for vertebral osteomyelitis between 2001 and 2011 were reviewed. Patients were divided into monomicrobial and polymicrobial cohorts based on type of infection.

When Do You Drain Epidural Abscesses of the Spine?

Background: How the relative volume of an epidural abscess on MRI affects outcomes with antibiotics alone has limited literature. The purpose of this study was to identify which infected epidural collections will reabsorb with antibiotics alone. Specifically, what is the critical size and enhancement on contrast MRIs to require a drainage procedure?

Materials And Methods: A retrospective review of all spinal osteomyelitis patients from 2001-2012 was performed.

Delay in Diagnosis of Vertebral Osteomyelitis Affects the Utility of Cultures.

Introduction: Obtaining blood or tissue cultures prior to administration of antibiotics has been the standard of care in the treatment of osteomyelitis of the spine. A delay in diagnosis of vertebral osteomyelitis is the primary culprit for the inaccuracy of blood cultures and biopsies. The purpose of this study was to evaluate the outcomes of spinal osteomyelitis in patients where the infecting organism was identified through cultures in contrast to cases where the cultures continued to be negative.

Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Outpatient Setting.

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been shown to have long-term clinical outcomes similar to those with open TLIF and decreased perioperative morbidity. This study assessed whether this procedure can be safely performed in outpatient settings. Ninety-six consecutive patients undergoing 1- or 2-level MIS-TLIFs were retrospectively reviewed.

Intraoperative Neuromonitoring for Anterior Cervical Spine Surgery: What Is the Evidence?

Study Design: Systematic review and meta-analysis.

Objective: The goal of this study was to (i) assess the risk of neurological injury after anterior cervical spine surgery (ACSS) with and without intraoperative neuromonitoring (ION) and (ii) evaluate differences in the sensitivity and specificity of ION for ACSS.

Summary Of Background Data: Although ION is used to detect impending neurological injuries in deformity surgery, it's utility in ACSS remains controversial.

Comparison of Instrumented and Noninstrumented Surgical Treatment of Severe Vertebral Osteomyelitis.

The purpose of this study was to compare the outcomes of instrumented versus noninstrumented (decompression) surgical treatment of vertebral osteomyelitis. The study population included 104 patients with spinal osteomyelitis who were treated at the authors' institution between 2004 and 2012. This included 62 men and 42 women who underwent either instrumented (n=57) or noninstrumented (n=47) surgery.

Routine Use of Intraoperative Neuromonitoring During ACDFs for the Treatment of Spondylotic Myelopathy and Radiculopathy Is Questionable: A Review of 15,395 Cases.

Study Design: A retrospective database study.

Objective: The goal of this study was to (1) evaluate the trends in the use of intraoperative neuromonitoring (ION) for anterior cervical discectomy and fusion (ACDF) surgery in the United States and (2) assess the incidence of neurological injuries after ACDFs with and without ION.

Summary Of Background Data: Somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs) are the commonly used ION modalities for ACDFs.

Preoperative halo-gravity traction with and without thoracoscopic anterior release for skeletal dysplasia patients with severe kyphoscoliosis.

Purpose: Recent work has shown the safety and efficacy of halo-gravity traction as an operative adjunct. However, there are no reports specifically looking at halo-gravity traction in patients with skeletal dysplasia. Our purpose was to assess the safety and efficacy of traction in children with skeletal dysplasia who present with severe kyphoscoliosis.

Paraspinal Muscle Atrophy After Lumbar Spine Surgery.

Paraspinal muscles are commonly affected during spine surgery. The purpose of this study was to assess the potential factors that contribute to paraspinal muscle atrophy (PMA) after lumbar spine surgery. A comprehensive review of the available English literature, including relevant abstracts and references of articles selected for review, was conducted to identify studies that reported PMA after spinal surgery.